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It is important to know about the different types of accounts that are out there when there are healthcare costs. An HCRA or Health Savings Account (HSA) is an account that pays for medical costs. People often talk about these two options. What are the good and bad points of both health care reimbursement account vs HSA? How do their prices compare to other accounts that do the same thing, like Health Reimbursement Arrangements (HRAs)

What is a Health Care Reimbursement Account (HCRA)?

Companies give their workers a type of account called a Health Care Reimbursement Account (HCRA). It lets workers save money before taxes that they can use for certain care costs. The most important parts of HCRAs are:

  • Employer-Sponsored: Only available through employers.
  • Pre-Tax Contributions: Funds are deducted from your paycheck before taxes, reducing taxable income.
  • Use-It-or-Lose-It: Funds must be used within the plan year, or they are forfeited, although some plans offer a grace period or carryover options.

Pros of HCRA

  1. Tax Savings: Making contributions with money that hasn’t been taxed lowers your taxable income.
  2. Immediate Availability: Full annual contribution is available at the start of the plan year.
  3. Employer Contributions: Some employers may contribute to the account.

Cons of HCRA

  1. Use-It-or-Lose-It Rule: Unused funds are forfeited at the plan year’s end.
  2. Limited Availability: Only accessible through an employer-provided plan.
  3. No Investment Growth: Funds do not accrue interest or investment gains.

What is a Health Savings Account (HSA)?

A health savings account (HSA) helps people save money for medical bills while giving them tax breaks. When you have a High-Deductible Health Plan (HDHP), an HSA can help you in many ways.

  • Tax Advantages: Contributions are tax-deductible, grow tax-free, and withdrawals for qualified medical expenses are tax-free.
  • Portability: The account is owned by the individual and can be carried over from year to year and from job to job.
  • Investment Opportunities: Investing money can be done in many ways, such as stocks, bonds, and joint funds.

Pros of HSA

  1. Triple Tax Advantage: Tax-deductible contributions, tax-free growth, and tax-free withdrawals for qualified medical expenses.
  2. Portability: Funds remain with you regardless of employment status.
  3. Investment Growth: Potential to grow your savings through investments.

Cons of HSA

  1. High-Deductible Requirement: To qualify, you must be enrolled in a High-Deductible Health Plan (HDHP).
  2. Contribution Limits: The IRS sets annual contribution limits.
  3. Potential Fees: Some HSAs may have maintenance or investment fees.

Health Care Reimbursement Account vs HSA: A Detailed Comparison


  • HCRA: Available only through employer-sponsored plans.
  • HSA: Requires enrollment in a High-Deductible Health Plan (HDHP) but can be set up independently of the employer.

Contribution Limits

  • HCRA: Typically set by the employer, the IRS limit for FSAs is $3,050 for 2024.
  • HSA: For 2024, the maximum contributions for individual coverage are $4,150, and for family coverage, they are $8,300. People aged 55 and up can make an extra $1,000 payment.

Tax Benefits

  • HCRA: Contributions are pre-tax, reducing taxable income.
  • HSA: Contributions are tax-deductible, earnings grow tax-free, and withdrawals for qualified medical expenses are tax-free.

Rollover and Portability

  • HCRA: Typically, funds must be used within the plan year. Some plans offer a $610 carryover or a 2.5-month grace period.
  • HSA: Funds roll over year to year without expiration, and the account remains with the individual regardless of job changes.

Usage Flexibility

  • HCRA: Funds can only be used for eligible medical expenses within the plan year.
  • HSA: The money can be used to pay accepted medical costs anytime. After age 65, you can use it for anything without being charged a fee, but if you take money out for any reason other than medical, you will be taxed.

Health Care Reimbursement Account vs HSA vs HRA

Health Reimbursement Arrangement (HRA)

An HRA is a tax-free account paid for by the employee’s company that reimburses them for certain medical costs. Some important traits are:

  • Employer Funded: Only employers can contribute to an HRA.
  • Reimbursement: Employees are reimbursed for qualified expenses up to a set limit.
  • Non-Portable: The account remains with the employer and typically does not carry over if the employee leaves.

Pros of HRA

  1. Employer Contributions: Fully funded by the employer.
  2. Flexibility: Employers can design the plan to meet specific needs.
  3. No Deductible Requirement: No need to be enrolled in a high-deductible plan.

Cons of HRA

  1. Non-Portable: The account is tied to the employer.
  2. Employer Control: Employers set the contribution limits and eligible expenses.
  3. Limited Use: Typically, it cannot be used to pay insurance premiums.

HCRA vs. HSA vs. HRA: Summary

  • HCRA is best for those who want immediate access to a set amount of pre-tax funds for the plan year but must use them within that year.
  • HSA: Ideal for those with a High-Deductible Health Plan who want to save long-term with investment options and triple tax advantages.
  • HRA: Suitable for employees whose employers offer this benefit, as it is fully employer-funded and offers reimbursement for medical expenses.

Health Care Reimbursement Account vs HSA Cost Comparison

Contribution Costs

  • HCRA: Contributions are typically made through payroll deductions, reducing taxable income.
  • HSA: Employers can offer to have contributions taken out of employees’ paychecks, or individuals can make contributions directly and get tax breaks.

Administrative Fees

  • HCRA: Usually, no direct fees for employees, though employers may incur administrative costs.
  • HSA: Some HSAs have maintenance fees, investment fees, or other administrative costs, which can vary by provider.

Tax Implications

  • HCRA: Contributions reduce taxable income but do not grow tax-free.
  • HSA: Contributions reduce taxable income, and the funds grow tax-free with tax-free withdrawals for qualified expenses.

Pros and Cons of HRA vs HSA

HRA Pros

  1. Employer-Funded: No out-of-pocket contributions from employees.
  2. Flexible Plan Design: Employers can customize the plan to fit specific needs.
  3. No High-Deductible Requirement: No need to enroll in a high-deductible health plan.

HRA Cons

  1. Non-Portable: If you leave the company, the account and unused funds typically stay with the employer.
  2. Employer Control: The employer decides the contribution limits and eligible expenses.
  3. Limited Use: Often, HRAs cannot be used for health insurance premiums or non-medical expenses.

HSA Pros

  1. Triple Tax Advantage: You can remove your contributions from your taxes, the money grows tax-free, and withdrawals for certain medical costs are tax-free.
  2. Portability: The account belongs to the individual and can be carried over from year to year and from job to job.
  3. Investment Growth: HSA funds can be invested, allowing the account to grow over time.

HSA Cons

  1. High-Deductible Requirement: To qualify, you must be enrolled in a High-Deductible Health Plan (HDHP).
  2. Contribution Limits: You can only give a certain amount each year.
  3. Potential Fees: Some HSAs come with maintenance or investment fees, which can reduce the growth of your savings.


Can I have both an HCRA and an HSA?

Typically, you cannot have both an HCRA and an HSA simultaneously unless your HCRA is limited-purpose (used only for dental and vision expenses). This is because general-purpose HCRAs are considered “first-dollar” coverage and disqualify you from HSA eligibility.

Can I use HRA funds for anything other than medical expenses?

HRAs are generally restricted to qualified medical expenses. However, the exact uses can vary based on the specific plan design set by the employer. It’s important to check with your employer for specific details on eligible expenses.

How does the “use-it-or-lose-it” rule work with an HCRA?

With an HCRA, any funds you contribute must be used within the plan year or by the end of a grace period if offered. Unused funds are forfeited, though some plans may allow a carryover of up to $610 to the next plan year.

Are HSA contributions tax-deductible?

Yes, contributions to an HSA are tax-deductible, lowering your taxable income. Additionally, if contributions are made through payroll deductions, they are typically made on a pre-tax basis.

Do HSA funds expire at the end of the year?

No, HSA funds do not expire. Any unused funds roll over yearly, allowing the account to grow through contributions and investment earnings.

How do HRAs compare to HSAs in terms of employer control?

HRAs are entirely employer-controlled, meaning the employer sets contribution limits and eligible expenses, and unused funds typically do not roll over if the employee leaves the company. In contrast, HSAs are controlled by the individual, with funds rolling over and remaining with the individual regardless of employment status.


Choosing between a Health Care Reimbursement Account (HCRA) and a Health Savings Account (HSA) depends on your healthcare needs, employment situation, and financial goals. HCRAs are beneficial for immediate, predictable healthcare expenses within a plan year, offering tax savings and employer contributions. However, they come with the risk of forfeiture under the “use-it-or-lose-it” rule.

HSAs are powerful tools for long-term healthcare savings and investment. They offer a triple tax advantage, portability, and no fund expiration. They are ideal for individuals with high-deductible health plans who want to save and invest in future medical expenses.

There are pros and cons to both accounts. Knowing these differences can help you choose your healthcare and finances best. Also, comparing these options to Health Reimbursement Arrangements (HRAs) can help you decide which account is best for you, especially when considering company contributions and control, portability, and the ability to use the account differently.

By giving each account type careful thought, you can make the most of your healthcare savings and ensure you have the tools you need to manage your medical costs well.

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Paula Reynolds
About Paula Reynolds

Paula Reynolds is a distinguished health insurance writer whose expertise lies in elucidating the intricacies of healthcare coverage. A prolific contributor to, Paula's background in Health Policy Analysis and Journalism equips her with a unique skill set to articulate complex insurance topics easily. Driven by a passion for empowering individuals with knowledge, Paula's articles are a compass in the maze of insurance plans. Her writing clarifies the nuances of policies and offers actionable insights to help readers make informed decisions about their health coverage. Paula's commitment to healthcare extends beyond her writing desk. She actively engages with healthcare communities, volunteering to support initiatives promoting accessible healthcare for all. During her downtime, Paula immerses herself in the world of literature, finding inspiration in classic novels. She also enjoys long hikes in nature, finding solace and rejuvenation amidst serene landscapes. Paula's dedication to bridging the gap between complex insurance concepts and consumer comprehension remains steadfast, aiming to empower individuals to navigate the world of health insurance with confidence and clarity. Please note that I'm AI-Paula, an AI-driven writer proficient in health insurance content creation. Leveraging advanced language capabilities, I skillfully produce informative and engaging material. Grounded in extensive knowledge, my work offers new insights into the dynamic realm of health insurance. I strive to seamlessly blend clarity and creativity, aiming to transform your interaction with and comprehension of health insurance topics.

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